TAP Health Equality Campaign Blog 6

Child Health, Poverty and Inequality

Kate Pickett and Richard Wilkinson

We tolerate overblown salaries and tax avoidance and shocking childhood deprivation in the UK

Summary

How many landmark reports do we need about the state of child health in the UK before Government takes action. In the first of Unicef’s series of reports on child wellbeing in rich countries, published in 2007, the UK came rock bottom of the international league table. We ranked 22nd worst on children living in poverty in Unicef’s 2010 report, and 24th for educational wellbeing in 2013. In 2014 we ranked 19th worst for inequalities in child health, 20th for inequalities in children’s life satisfaction and 26th for educational inequalities; a shabby record for the second richest country in Europe, by GDP per capita.

The real drivers of inequalities in child health are the socioeconomic inequalities that our current government does NOT see as a priority, does NOT seek to address, and in fact enacts policies that can only make the situation worse. Austerity economics don’t help, enlarging the number of grammar schools will not help, and demonising the poor won’t help.

What might actually work? We need:

To tackle income inequality, Win a Living Wage for all workers (and by that we mean a real Living Wage, not the so-called ‘national living wage’, which is simply a long-overdue but still inadequate rise in the minimum wage).

To provide proper funding for preventive services and treatment for mental health issues that limit so many family’s abilities to provide an optimally nurturing environment for their children.

To tackle debt and regulate loan sharks.

Child Health, Poverty and Inequality

Kate Pickett and Richard Wilkinson

We tolerate overblown salaries and tax avoidance and shocking childhood deprivation in the UK

In January this year the Royal College of Paediatrics and Child Health published what the Guardian and other newspapers described as a ‘landmark’ report on the state of child health in the UK. This snapshot of 25 measures of child health showed alarming gaps between the health of children in the UK, compared to our European neighbours, and shocking inequalities between UK children from the most deprived backgrounds, compared to those from the most affluent families.

Almost one in five children in the UK is living in poverty. We rank 15th out of 19 countries on deaths among infants during their first year of life. The report says ‘The strongest determinants of child health across every indicator are social, educational and economic factors.’

Child health is important not just for its own sake, but also because it casts a long shadow forward over health in later life. The Report says that poor health in childhood ‘mediated through disadvantage and deprivation’ affects both mental and physical health in adulthood. ‘The growing burden of chronic, long-term conditions that have a substantial component of their origins in early life – obesity, cardiovascular disease, vascular dementia and diabetes – are placing a strain upon the NHS and adversely affecting the health and economic wellbeing of the nation.’

But in truth, although the Royal College’s report is an important record of the UK’s current woeful state of child health, the report is not so much a ‘landmark’ as an update and restatement of a longstanding message that governments have repeatedly failed to hear.

The UK has a tradition of excellent research and government-commissioned reports on health inequalities, including the Black Report in 1980, the Acheson Report in 1998 and the Marmot Review in 2010. All documented vast differences in the health and wellbeing of children in the UK, according to their family backgrounds.

Data in the Black Report showed that throughout the 1970’s infant mortality was two to two-and-half times higher in the lowest social class compared to the highest. Although this gap fluctuated through the 1990s and 2000s, now we’re back to that doubled risk: infant mortality is once again twice as high in the poorest families, compared to the most affluent.

And it certainly isn’t news that our children fare less well than children in other developed countries. In the first of Unicef’s series of reports on child wellbeing in rich countries, published in 2007, the UK came rock bottom of the international league table. We ranked 22nd worst on children living in poverty in Unicef’s 2010 report, and 24th for educational wellbeing in 2013. In 2014 we ranked 19th worst for inequalities in child health, 20th for inequalities in children’s life satisfaction and 26th for educational inequalities; a shabby record for the second richest country in Europe, by GDP per capita.

The Black Report made recommendations ‘to give children a better start in life’. The Acheson Report recommended that ‘a high priority is given to policies aimed at improving health and reducing health inequalities in women of childbearing age, expectant mothers and young children.’ The Marmot Review’s first policy objective was to ‘give every child the best start in life’.

It couldn’t be clearer, could it? And in response to the Royal College’s report last month, a Department of Health spokesperson said ‘we are determined to tackle health inequalities and help children and families lead healthier lives.’

Maybe that’s true for the civil servants in the Department of Health but it certainly isn’t reflected in government policy. The real drivers of inequalities in child health are the socioeconomic inequalities that our current government does NOT see as a priority, does NOT seek to address, and in fact enacts policies that can only make the situation worse. Austerity economics don’t help, enlarging the number of grammar schools will not help, and demonising the poor won’t help.

What might actually work?

We have shown that changes in income inequality over a 10 year period are significantly related to changes in child wellbeing. If we tackle income inequality we can improve average levels of child wellbeing, reduce inequalities, improve social mobility and make progress towards giving all of our children an equal chance in life. We need to reduce in-work poverty – more than half of poor children in the UK live in families with at least one working adult. But we also need to tackle inequality that is driven by top earners – we all do less well in unequal societies. Even the children of highly educated, affluent, upper class families do worse in the UK than if they lived in similar families in more equal countries, like our Scandinavian neighbours.

This means we need to alleviate the deep, structural inequalities that exist in the UK. We need to win a Living Wage for all workers (and by that we mean a real Living Wage, not the so-called ‘national living wage’, which is simply a long-overdue but still inadequate rise in the minimum wage). We need a child basic income, one of the 15 policies called for by Professor Tony Atkinson, world-leading expert on inequality, who died earlier this year. We need to curb top incomes and the ridiculous culture of runaway salaries and bonuses that not only harm population health and wellbeing, but also damage our economic performance. We need serious investment in early childhood interventions instead of imposing harsh budget cuts on Sure Start. We need to provide proper funding for preventive services and treatment for mental health issues that limit so many family’s abilities to provide an optimally nurturing environment for their children. We need to tackle debt and regulate loan sharks.

The fact that we do now know how to tackle these issues raises fundamental issues of the moral culpability of governments which, rather than taking effective action, prefer to tolerate overblown salaries and tax avoidance at the top. As two academics, one working and one retired, we would be glad to pay higher taxes as a step towards reducing poverty and inequality.